探析中间入路与左侧前入路在中老年进展期胃癌（AGC）腹腔镜根治术中的应用效果。

回顾性分析2022年1月至12月接受腹腔镜根治术的91例中老年局部AGC患者资料，按照手术入路方式分组。中间组46例患者接受中间入路；左前组45例患者接受左侧前入路。采用SPSS 25.0软件分析数据。计量资料以（±s）表示，采用独立样本t检验；计数资料以[例（%）]表示，行χ²检验或Fisher精确检验；用Kaplan-Meier法行生存分析。P<0.05为差异有统计学意义。

两组患者术中淋巴结清扫数量、术后24h血清C反应蛋白（CRP）、超氧化物歧化酶（SOD）水平、并发症发生率比较，差异无统计学意义（P>0.05）；中间组患者手术时间、术中出血量均小于左前组（P<0.05）。关腹前，中间组血清多巴脱羧酶（DDC）、癌胚抗原（CEA）水平低于左前组（P<0.05）；中间组术后3年复发率低于左前组（P<0.05）。中间组患者随访3年总生存率87.0%高于左前组68.9%，且无进展生存期、总生存期均长于左前组（P<0.05）。

中间入路与左侧前入路腹腔镜根治术应用于中老年局部AGC治疗，在术中淋巴结清扫数量、术后应激反应、并发症等方面差异无统计学意义，但相较左侧前入路，中间入路手术时间短、术中出血量少，术后3年复发率较低，且无进展生存期和总生存期延长。

To explore the application effects of the intermediate approach and the left anterior approach in laparoscopic radical resection for advanced gastric cancer (AGC) in middle-aged and elderly patients.

The data of 91 middle-aged and elderly patients with localized AGC who underwent laparoscopic radical resection from January to December 2022 were retrospectively analyzed. The patients were grouped according to the surgical approach. 46 patients in the intermediate group received the intermediate approach; 45 patients in the left anterior group received the left anterior approach. Data were analyzed using SPSS 25.0 software. Quantitative data were expressed as (±s), and independent sample t test were used; count data were expressed as [cases (%)], and χ² tests or Fisher’s exact tests were performed; survival analysis was conducted using the Kaplan-Meier method. P<0.05 was considered statistically significant.

There were no statistically significant differences in the number of lymph node dissections during the operation, 24-hour postoperative serum C-reactive protein (CRP), superoxide dismutase (SOD) levels, and complication rates between the two groups (P>0.05); the operation time and intraoperative blood loss of the intermediate group were less than those of the left anterior group (P<0.05). Before closure, the serum dopa decarboxylase (DDC) and carcinoembryonic antigen (CEA) levels of the intermediate group were lower than those of the left anterior group (P<0.05); the 3-year recurrence rate of the intermediate group was lower than that of the left anterior group (P<0.05). The 3-year overall survival rate of the intermediate group was 87.0%, which was higher than that of the left anterior group (68.9%), and the disease-free survival period and overall survival period were longer than those of the left anterior group (P<0.05).

The intermediate approach and the left anterior approach laparoscopic radical resection for AGC in middle-aged and elderly patients have no statistically significant differences in the number of lymph node dissections during the operation, postoperative stress response, and complications. However, compared with the left anterior approach, the intermediate approach has shorter operation time, less intraoperative blood loss, lower 3-year recurrence rate, and longer disease-free survival period and overall survival period.